Keywords
Pronóstico
Variabilidad de la frecuencia cardiaca
Estudio de cohortes Myocardial infarction
Prognosis
Heart rate variability
Cohort study
How to Cite
Abstract
To evaluate the association of the heart rate variability (HRV) as a prognosis factor of morbidity and mortality in patients in acute phase (intra-hospital) of myocardial infarction (AMI). Design: prospective cohort study. Population: included were 173 patients with first myocardial infarction recruited from the University Hospital of Santander and Colombian Cardiovascular Foundation in Bucaramanga, Colombia between April 1 2003 to December 31 2007. Patients with autonomic disorders, such as diabetes, were excluded. Comparisons: HRV in patients with outcome versus without outcome. Outcomes: sudden and non-sudden death, angina post-AMI, reinfarction, cardiac arrhythmias, heart failure and complicated versus non complicatd patients. Methods: HRV was measured in three consecutive opportunities, five minutes each one, in the first 12 hours of arrival to the emergency department. Biopac MP35 was used to register the digital electrocardiogram and software AMI 2.0 was used in the processing and signal analysis. Follow-up: all the included patients were followed from their entry into the emergency department until discharge from the hospital. They were assessed for any outcome. Statistical analysis: mean and standard deviation were used for quantitative variables and proportion was used for the qualitatives. The differences were evaluated using t student and chi-square. A bivariate analysis was made. Relative risk (RR) and confidence interval of 95% were used. An analysis was carried out using survival curves analysis of Kaplan-Meier and evaluating differences through the log rank test. Results: among the 173 patients the mean age was 63.11 years (ranging from 28-96). Those with anterior myocardial infarction were 55.5% (n = 96). The average ejection fraction was 43.8% (SD: 14.52%). The following outcomes were found: angina post-IAM (41.04%), heart failure (20.81%), cardiac arrhythmia (15.61%), non sudden death (6.36%), sudden death (3.47%) and reinfarction at 2.3%. For heart failure, an ejection fraction of <40% showed a RR 3.26 (CI95% 1.76-6.04), aged over 65 years with RR 1.89 (CI95% 1.01-3.53), low values HF with RR 2.36 (CI95% 1,1-5,06), LF RR 2.36 (CI95% 1,1-5,06) and LFnu RR: 2.76 (CI95% 1.15-6.63). For the outcome of cardiac arrhythmia, low values of VFC as MDARR RR0.25 (CI95% 0.11-0.57), MIRR RR 0.27 (CI95% 0.12-0.62) and PNN50 RR 0.35 (CI95% 0.16-0.75) had a significant association as protective factors. Conclusions: low values of HF, LF and LFnu were significantly associated with the outcome of heart failure in the acute phase of myocardial infarction. By contrast, low values MDARR, MIRR and PNN50 are protectors for development of cardiac arrhythmias in the acute phase of a myocardial infarction. The VFC was not associated with other outcomes such as sudden death and non sudden, post-infarction angina, reinfarction and global complications.
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